Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Specific and sensitive diagnostic tests are now available to identify type A, B, C, D and E hepatitis. Hepatitis A and E which cause only acute, very rarely fulminant, hepatitis are spread largely by the faecal-oral route, having a brief viraemic phase. Hepatitis B, C and D which are transmitted parenterally and via secretions are often associated with chronic viraemia. Patients with chronic renal disease are at particular risk. Impaired immunity due to disease or drugs increases the propensity to develop a chronic carrier state which may progress to cirrhosis and hepatocellular carcinoma. Limited reports indicate that hepatitis C infection may cause cirrhosis more rapidly than hepatitis B. The emergence of mutants to both hepatitis B and C is a cause for concern. Treatment with interferon is of limited efficacy. Screening of blood products for viral markers and prudent handling of potentially infected materials to avoid contamination of damaged skin or mucous membrane are the best strategies to prevent infection. Hepatitis B vaccination of all newborns, young adolescents and those at risk is the most effective means of reducing the carrier frequency.
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PMID:Viral hepatitis in children with renal disease. 781 14

The major cause of liver diseases world-wide are the infectious hepatitis A-E which are due for different viruses. Most of the cases are clinically asymptomatic and without jaundice with a high rate of cure. The diagnosis and the differentiation of the various clinical syndromes are based mainly on serological markers of the involved antigen-antibody-systems. For insurance purposes the chronic hepatitis B, C and D are of great importance. Where chronic persistent hepatitis has a nearly normal life expectancy, chronic active hepatitis which may develop into cirrhosis and/or hepatocellular carcinoma has an increased mortality.
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PMID:[Viral hepatitis. Insurance medicine observations]. 782 66

We report the first series of 9 auxiliary liver transplantations performed as a bridge to recovery in 8 patients with fulminant and subfulminant hepatic failure. Hepatic failure was due to hepatitis A virus (n = 3), hepatitis B virus (n = 1), hepatotoxic drugs (n = 2), autoimmune disease (n = 1), or it was of unknown origin (n = 1). The donor liver was reduced to a left lobe (n = 2), a left liver (n = 4), or a right liver (n = 3), and was implanted in an orthotopic position beside the native liver after it was resected by a left or a right hepatectomy. Conventional immunosuppression was used to prevent rejection. Six patients regained normal consciousness within 2 weeks, without any sequelae. Two patients had persisting encephalopathy due to graft initial dysfunction, one of whom showed portal vein thrombosis, which was successfully cleared. The other one showed hepatic vein stenosis and was retransplanted at day 15. Five of eight patients had to be reoperated because of a surgical complication. Five patients showed rapid regeneration of their native liver, but one died at day 45 from severe herpes virus broncholitis. The auxiliary grafts were removed (n = 3) or left to atrophy by tapering immunosuppression (n = 1). One patient developed cirrhosis of the native liver and died of infectious complications at day 42. The native livers of the two remaining patients are still atrophic, one at 4 months and one at 1 month posttransplant. Finally, 6 of 8 patients are alive with a follow-up of 1 to 17 months. Four of them have permanently stopped their immunosuppressive therapy. Our experience demonstrates that auxiliary orthotopic liver transplantation (1) is feasible in children and adults, using either a left or a right liver graft, (2) is efficient in providing adequate liver function, and (3) gives a real chance to the native liver to regenerate, offering these patients a future free of immunosuppression.
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PMID:Auxiliary liver transplantation for fulminant and subfulminant hepatic failure. 783 43

The inner city population of the Los Angeles county has rapidly become largely Latino. The 3.3 million Latinos living in the county in 1990 had much higher poverty rates and lower educational attainment rates than Anglo (non-Hispanic white) or blacks. The health indicators of the three groups are compared for 1990. In birth outcome, although Latinos were the least likely to receive care in the first trimester, Latinos and Anglos had identical rates of low birth weight babies, and lower rates than blacks. Latino infant mortality was the lowest of the three. The age-adjusted death rates showed that Latinos have a lower overall death rate than Anglos or blacks, and lower specific rates for heart disease, cancer, AIDS and stroke. Latinos did have higher death rates than Anglos for accidents, homicides, cirrhosis and diabetes. Latinos had incidence rates of gonorrhoea and syphilis similar to Anglos and lower than blacks. The communicable disease rates for Latinos was many times higher than Anglos or blacks, including those for measles, shigellosis, giardiasis and hepatitis A. Implications for family medicine are discussed.
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PMID:Latino health in Los Angeles: family medicine in a changing minority context. 784 24

Viral causes of acute or chronic hepatitis are the hepatitis A virus [HAV], the hepatitis B virus [HBV], the hepatitis C virus [HCV], the hepatitis delta virus [HDV], and the hepatitis E virus [HEV]. These viruses haven been characterized in great detail and can be detected by specific and sensitive serological or molecular assays. While HAV and HEV cause only acute hepatitis, infection with HBV, HCV or HDV frequently takes a chronic course. With time chronic viral hepatitis can progress to liver cirrhosis and its clinical sequelae as well as to hepatocellular carcinoma [HCC]. Apart from prophylactic measures aimed at the prevention of these viral infections, for those chronically infected natural or recombinant alpha-interferon may be a therapeutic option with the potential to prevent the development of liver cirrhosis and HCC.
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PMID:[Viral hepatitis A to E--diagnosis, clinical aspects and therapy]. 794 Apr 9

To study the influence of chronic hepatitis on intercellular adhesion molecule-1 serum concentration, we measured intercellular adhesion molecule-1 in the serum of 84 patients with chronic liver disease (17 chronic persistent hepatitis, 42 chronic active hepatitis and 25 active cirrhosis) caused by hepatitis B virus (n = 46), hepatitis C virus (n = 10) and autoimmunity (n = 28). Furthermore, 20 patients with acute viral hepatitis (16 hepatitis B virus and 4 hepatitis A virus) and 6 patients with acute drug-induced hepatitis were included. Sera from 20 healthy persons were used as control. Follow-up examinations were performed during immunosuppressive therapy in 20 patients with autoimmune chronic liver disease (13 chronic active hepatitis and 7 active cirrhosis). Intercellular adhesion molecule-1 serum concentration was significantly increased in patients with acute viral hepatitis, drug-induced hepatitis, chronic active hepatitis and active cirrhosis compared with healthy controls and with patients with chronic persistent hepatitis. Intercellular adhesion molecule-1 was also significantly increased in severe chronic active hepatitis and active cirrhosis compared with moderate chronic active hepatitis and moderate active cirrhosis. Serum concentration of intercellular adhesion molecule-1 decreased significantly in patients with autoimmune chronic liver disease after 2 mo of immunosuppression when remission was present. A close correlation between aspartate aminotransferase and intercellular adhesion molecule-1 serum levels was found. We conclude the following: (a) in chronic liver disease intercellular adhesion molecule-1 serum concentration may represent, at least in part, hepatocellular damage; and (b) intercellular adhesion molecule-1 serum level does not differentiate between chronic autoimmune and chronic viral hepatitis.
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PMID:Intercellular adhesion molecule-1 concentration in sera of patients with acute and chronic liver disease: relationship to disease activity and cirrhosis. 810 56

Viral hepatitis comprises five different diseases caused by five different viral agents: hepatitis A, B, C, D, and E virus. All five forms can cause acute hepatitis, only hepatitis B, C and D can cause chronic hepatitis. Alpha interferon has been shown to be effective in inducing sustained remissions in all three forms of chronic viral hepatitis. Its efficacy in acute viral hepatitis has not been documented, although preliminary results suggest that interferon may decrease the chronicity rate of acute hepatitis C. In chronic hepatitis B, alpha interferon therapy with 5 mu daily or 10 mu three time weekly for 16 weeks will induce a long-term remission in disease with loss of HBV DNA and HBeAg from serum in 25% to 40% of patients and ultimately, a loss of HBsAg in approximately half of the responders. Patients likely to respond are those with high initial serum aminotransferases and low levels of HBV DNA. In chronic hepatitis C, therapy with 3 to 5 mu of alpha interferon 3 times weekly for 24 to 48 weeks will induce a temporary remission in disease with loss of HCV RNA from serum, fall of aminotransferases into the normal range and improvement in liver histology in 50% of patients and a sustained remission persisting after therapy is stopped in 25% of patients. Patients with a short duration of disease and without cirrhosis are the most likely to respond. Unfortunately, there are no completely reliable means of predicting which patients are likely to respond to interferon and which of these will have a lasting response. In chronic hepatitis D, a prolonged course of alpha interferon given in doses of 3 to 5 mu daily or 9 to 10 mu three times weekly results in remission in disease as marked by loss of HDV RNA from blood and fall of aminotransferases into the normal range in up to 50% of patients. Unfortunately, this response is rarely sustained after treatment unless HBsAg becomes negative, which occurs in only a small number of patients. Despite the benefits of alpha interferon therapy in many patients with chronic viral hepatitis, several shortcomings of this therapy are evident: less than 50% of patients respond, side effects can be problematical, and some patients are not appropriate for therapy. Thus, interferon is not indicated for patients with advanced cirrhosis or for those who are severely immunosuppressed. Alpha interferon is an important first step in therapy for chronic viral hepatitis, but further approaches are needed to increase its efficacy and safety.
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PMID:Therapy of acute and chronic viral hepatitis. 814 Sep 56

Viral hepatitis is a major public health problem in all parts of the world. Infections with hepatitis B are of particular concern since such infection in some individuals can lead to chronic liver disease, cirrhosis of the liver, and hepatocellular carcinoma. Comparative studies of the morbidity rates of hepatitis B and hepatitis A virus infections in various European countries indicate that these diseases are highly endemic in Romania. A 300 case per 100,000 population incidence was reported in 1989 national surveillance data for all types of viral hepatitis. A seroprevalence survey of viral hepatitis was conducted in Bucharest, Romania, during April-July 1990 on 1355 people from both the general population and groups at higher risk of infection. The low-risk sample was comprised of 201 individuals aged 0-16 years who had been admitted to the hospital for the first time in their life and who had a noninfectious diagnosis; 200 healthy adults who were attending premarital or recruitment medical examinations; and 204 pregnant women attending antenatal clinics. 214 children younger than three years old selected at random from the five orphanages in Bucharest and 336 medical personnel working at any of four health facilities in the city comprised the high-risk sample. ELISA was used to identify markers of hepatitis A, B, and C in sera. The prevalences of hepatitis A and B markers were high in all low-risk groups, with a past history of acute hepatitis reported by 10.5% of healthy adults. The prevalence of anti-hepatitis A markers increased with age. Almost two-thirds of the subjects younger than 20 years old had been infected with hepatitis A, 50.7% of the 77 children under 5 years old were positive for at least one hepatitis B virus marker, and 34.8% of individuals aged 5-19 years demonstrated seropositivity for hepatitis B virus. 47% of adults from the general population had at least one marker for hepatitis B, 7.8% of pregnant women were seropositive for hepatitis B surface antigen, and 54.6% of the infants aged 0-3 years living in orphanages had at least one marker for hepatitis B. Hepatitis C is circulating in the country. These results are consistent with national surveillance data and confirm that viral hepatitis is a major public health problem in Romania. Prevention measures must include hepatitis B immunization of infants, with an appropriately targeted immunization strategy determined through further epidemiological studies.
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PMID:Viral hepatitis in Bucharest. 831 96

Indications for liver transplant in acute fulminating hepatitis (AFH) are predominantly affected by the high mortality of this spontaneous evolution (80-100%). At present patients with AFH have priority for transplant since they form part of the 0 emergency group according to the National Transplant Organisation. During the period between 1986 and the end of February 1992, a total of 254 liver transplants were performed in 202 patients (52 retransplants). In 26 patients (12.8%) (16 females and 10 males) the indication was fulminating acute hepatitis. Etiology was unknown in 20 patients, secondary to hepatitis B in 4 and to hepatitis A in 1, and was caused by isonazide ingestion in 1 case. The age limits were 3-60 years (X = 31.5 years). An isogroup graft was performed in 16 patients (61.5%), compatible in 3 (11.6%) and incompatible in 7 (26.9%). Due to anthropometric differences, a partial graft was used in 7 patients (26.9%); in 2 of the latter the graft was taken from the same donor ("split-liver"). Placement was always orthotopic with resection of the retrohepatic vena cava in 25 patients and its preservation in 1 (left lobe of split-liver). Peroperative (30 days) mortality was 23% (6/26); 2 due to cerebral death, 2 due to sepsis, 1 due to multisystemic insufficiency (MSI) and 1 due to acute pancreatitis. Four patients (15.3%) died some time after transplant; 1 after 5 months due to broncho-pulmonary complications, 1 after 7 months due to subacute hepatitis, 1 after 3 months due to respiratory failure and the last after 5 months due to anoxic encephalopathy and lung infection. Ten patients (39.4%) were re-transplanted; 4 following chronic rejection, 4 due to primary graft no function, 1 due to arterial thrombosis and 1 due to recurrent hepatitis (with cirrhosis). Two of the latter patients died intraoperatively due to coagulopathy and hemorrhage, and 3 following surgery (1 due to sepsis, 1 due to respiratory complications and 1 due to respiratory insufficiency). Two patients underwent a second re-transplant (1 due to chronic rejection and 1 due to recurrent hepatitis) and of these 1 died peroperatively due to sepsis and MSF. Overall mortality was therefore 61.5% (16/26) and the actuarial survival rate of 17 patients (10 living + 7 postoperative deaths) was 68% at 12 months and 52.9% at 36 months. Even if peroperative mortality is relatively high, liver transplant is currently the elective treatment for fulminating acute hepatitis.
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PMID:[The treatment of acute liver failure due to fulminating hepatitis by total or partial orthotopic liver transplantation. The clinical results]. 832 33

To determine the most prevalent forms of hepatitis in intravenous heroin addicts, 389 addicts consecutively admitted to outpatient treatment clinics throughout California were tested for antibodies to hepatitis A (anti-HAV), B core (anti-HBc), B surface (anti-HBs), C (anti-HCV), D (anti-HDV), and B surface antigen (HBsAg). The majority were also tested for serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, lactic dehydrogenase, total bilirubin, globulins, albumin, and platelet count. The seroprevalence of each marker was: anti-HAV (40.7%); anti-Hbc (73.6%); anti-HBs (46.7%); anti-HCV (93.6%); anti-HDV (9.6%), and HBsAg (3.5%). No single case was positive for IgM, anti-HAV, or for both HBsAg and anti-HDV, indicating the presence of recent hepatitis A or hepatitis D infection. Abnormal liver enzymes, serum proteins, total bilirubin, and platelet count were found to be normal in 5.3 to 44.8% of anti-HCV cases indicating persistent infection. Among anti-HCV cases, elevated total bilirubin or a low platelet count was invariably associated with one or more liver enzyme and protein abnormalities. We conclude that while acute hepatitis may be frequent and caused by various viral types, hepatitis C is the primary form of chronic hepatitis found in intravenous heroin addicts. Almost half of hepatitis C cases demonstrate liver function abnormalities indicating persistent infection that has the potential to be contagious and progress to cirrhosis, liver failure, and hepatocellular carcinoma.
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PMID:Seroprevalence of hepatitis A, B, C, and D markers and liver function abnormalities in intravenous heroin addicts. 855 78


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